WO2023054658A1 - Medical device and method for collecting object - Google Patents

Medical device and method for collecting object Download PDF

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Publication number
WO2023054658A1
WO2023054658A1 PCT/JP2022/036630 JP2022036630W WO2023054658A1 WO 2023054658 A1 WO2023054658 A1 WO 2023054658A1 JP 2022036630 W JP2022036630 W JP 2022036630W WO 2023054658 A1 WO2023054658 A1 WO 2023054658A1
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Prior art keywords
medical device
sliding
cylindrical body
cylindrical
catheter
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PCT/JP2022/036630
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French (fr)
Japanese (ja)
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早川浩一
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テルモ株式会社
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions

Definitions

  • the present invention relates to medical devices and methods for retrieving objects.
  • Acute limb ischemia occurs when thrombi formed in the heart, aortic wall, etc. are released and peripheral lower limb arteries are occluded.
  • transcatheter-directed thrombolysis CDT
  • PMT percutaneous mechanical thrombectomy
  • PAT percutaneous aspiration thrombectomy
  • thrombectomy using a catheter having a balloon is effective when the thrombus is large or hard.
  • the skin is surgically incised to expose the femoral artery.
  • the femoral artery is then incised, a catheter is inserted into the vessel, and the deflated balloon is stretched to clear the blockage (or stenosis) caused by the thrombus before being inflated.
  • the balloon is then pulled proximally to move the thrombus to the blood vessel incision and out of the body through the incision.
  • US Patent Application Publication No. 2011/0213393 describes a method for removing a thrombus by inserting a thrombus removal device having a balloon into a blood vessel without incising the skin.
  • the balloon of the thrombectomy device draws the thrombus into a funnel-shaped tube that is expanded within the vessel.
  • the thrombus can be aspirated from the proximal side, and the thrombus in the funnel-shaped tube can be expelled from the body.
  • Japanese Patent Application Laid-Open No. 2018-143577 has two shaft portions and a cutting portion extending distally from the distal portions of the two shaft portions.
  • a medical device is described with a linear portion having an angled cutting edge.
  • the linear part with the cutting blade is inclined with respect to the shaft part, the object can be effectively crushed by moving within the capture device into which the object is drawn inside the biological lumen. .
  • the present invention aims to provide a medical device and method capable of efficiently recovering an in vivo object with a simple mechanism and a simple operation.
  • a medical device for retrieving an object comprising: a tubular body capable of accommodating the object inside; a sliding body that slides so as to fold back the outer surface and the inner surface through a folded portion located at the end of the cylindrical body, and the object is brought into contact with the sliding body at the tip portion of the cylindrical body to move the sliding body.
  • the sliding body has an inner end located on the inner surface of the cylindrical body, is inserted reciprocally through the interior of the cylindrical body, and is connected to the inner end of the sliding body.
  • the medical device according to [1] further comprising an elongated body.
  • [4] further comprising an expandable body inserted inside the cylindrical body or the elongated body, the expandable body having a catheter and an extendable expandable part fixed to the catheter, [2] or The medical device according to [3].
  • a method for recovering an object comprising: providing the medical device according to any one of [1] to [4]; A method, comprising: sliding a moving body; and retrieving the object into the interior of the tubular body.
  • the medical device further includes an expansion body inserted inside the tubular body and having a catheter and a stretchable expansion part fixed to the catheter, and the contacting step includes the expansion part.
  • the method of [5] comprising expanding, pulling the catheter, and guiding the object to the distal end of the tubular body with the expansion.
  • FIG. 1 is a conceptual diagram showing the distal end portion of the medical device according to the first embodiment of the present invention.
  • FIG. 2A is a conceptual diagram showing a medical device according to the first embodiment of the present invention and an example of its use
  • FIG. 2B is a conceptual diagram showing a method of recovering an object inside the cylindrical body of the medical device of FIG. 2A.
  • FIG. 3A is a conceptual diagram showing a medical device according to a second embodiment of the present invention and an example of its use
  • FIG. 3B is a conceptual diagram showing a method of recovering an object inside the cylindrical body of the medical device of FIG. 3A.
  • 4A is an explanatory diagram of the step of incising the skin and muscle fibers in the third embodiment
  • FIG. 4B is an explanatory diagram of the step of inserting the medical device of FIG. 1 into the incision of FIG. 4A
  • FIG. 1 is an illustration of the step of housing muscle fibers in one medical device;
  • FIG. 4A is an explanatory diagram of the step
  • an "object” is a “solid object” and an object that includes a solid part.
  • the object is, for example, in vivo, within a lumen, or within a body cavity.
  • objects include polyps, tissue fragments, fibroids, muscle fragments (muscle fibers), excretions in the digestive tract (feces, barium sulfate preparations, etc.), thrombi, indwelling objects (stents, filters, etc.), accidentally ingested foreign substances, This includes part of a broken medical device, part or all of a remaining medical device, etc.
  • medical device means a machine intended to be used for the diagnosis, treatment or prevention of diseases in humans or animals, or to affect the structure or function of the human or animal body. It refers to equipment, etc.
  • a “cylindrical body” refers to a substantially cylindrical member in which an object can be stored and collected.
  • a substantially cylindrical shape typically includes, for example, a cylindrical shape with a circular cross section obtained by rolling one plate-like member into a circular shape, and an object is accommodated inside it to be appropriately retrieved outside the body. can be done. That is, the tubular body has an arcuate portion (arcuate portion) having an inner surface for receiving the object and an outer surface opposite the inner surface.
  • the arch-shaped part has a square square shape including a U shape, and the inner concave surface is The inner surface and the opposite outer protruding surface are called the outer surface.
  • the arch-shaped part is an O shape including a C shape
  • the inner and outer surfaces are curved surfaces.
  • the arch-shaped portion refers to a square-shaped, U-shaped, O-shaped, or C-shaped arch-shaped portion of the cylindrical body.
  • the square shape includes the U shape
  • the O shape includes the C shape.
  • the recessed side of the arcuate portion may be referred to as the inner surface, concave surface, inner side, inner side, and the protruding side of the arched portion may be referred to as the outer surface, convex surface, outer side, or outer side.
  • the arch shape also includes an arc shape.
  • Either the inner surface or the outer surface of the arch-shaped portion may be flat.
  • the inner surface may be concave and the outer surface may be flat, or the inner surface may be flat and the outer surface may be convex.
  • the tubular body has rigidity, and by arranging an object on its concave surface, it is possible to properly hold the object without detaching it to the outside.
  • the cylindrical body may have at least a portion of an arched portion with a concave surface, and may be a member with a semicircular, circular, quadrangular, or polygonal cross section.
  • the tubular body is preferably elongated so that objects can be properly drawn into it.
  • the tubular body can also be made of a flexible material so that it can be freely bent according to the shape of the lumen or body cavity.
  • the material for the cylindrical body is not particularly limited, and various known materials can be used singly or in combination. Examples of such materials include metals, soft vinyl chloride resins, polyurethane resins, silicone rubbers, natural rubbers, synthetic rubbers, styrene-ethylene-butylene-styrene copolymers (SEBS), styrene-ethylene-propylene-styrene copolymers.
  • SEBS styrene-ethylene-butylene-styrene copolymers
  • SEPS Polymer
  • EVA ethylene vinyl acetate copolymer
  • nylon and other polyamide resins and polyamide elastomers polyethylene terephthalate (PET) and other polyester resins and polyester elastomers, polyethylene and other olefinic resins, fluororubbers, fluororesins , polystyrene, polymethyl methacrylate, polycarbonate, polyimide, polyetherimide, polyetheretherketone, etc., and one or more of these may be used in combination.
  • the “sliding body” refers to a belt-shaped body that can slide along the surface of a cylindrical body.
  • the strip has a cylindrical shape that can slide along the surface shape of the cylindrical body.
  • the sliding body slides along the longitudinal direction of the cylindrical body and is folded back at the tip of the cylindrical body, thereby moving from the inner surface to the outer surface and from the outer surface to the inner surface.
  • the sliding body moves from the outer surface of the cylindrical body to the inner surface of the cylindrical body by being folded back at the tip, thereby sliding on the cylindrical body like a belt conveyor and bringing the object into contact with the sliding body, thereby moving the object into the cylinder. It can be pulled inside the body.
  • the "long body” refers to a long member that can be inserted into the cylindrical body so as to advance and retreat.
  • a part of the long body can be connected to the inner end of the sliding body, and by moving the long body relative to the tubular body, the sliding body can be moved relative to the tubular body. can be moved sensibly.
  • the elongated body can also be configured in the shape of a pipe having a cavity inside.
  • FIG. 1 is a conceptual diagram showing the tip portion of the medical device according to the first embodiment of the present invention
  • FIG. 2 is a conceptual diagram showing a usage example of the medical device according to the first embodiment of the present invention
  • FIG. It is a figure which shows the modification of the medical device which concerns on the 2nd embodiment of this invention.
  • the size of each member is appropriately emphasized for ease of explanation, and each member shown does not indicate the actual size.
  • a medical device 1 according to a first embodiment of the invention includes a tubular body 2 and a sliding body 3.
  • the cylindrical body 2 is a long cylindrical body having a cylindrical shape, and has an O-shaped arch-shaped portion 21 .
  • the inner surface 2a of the cylindrical body 2 has a concave surface and the outer surface 2b has a convex surface.
  • the sliding body 3 is a long belt-like body having a cylindrical shape that can slide along the shape of the tubular body 2 .
  • the sliding member 3 is made of a flexible resin sheet, elastomer sheet, elastic cloth, or the like.
  • the sliding body 3 covers part of the inner surface 2a and part of the outer surface 2b of the cylindrical body 2 in the initial state before use.
  • the sliding member 3 has a folded portion 3a positioned at the tip portion 2c of the cylindrical member 2. As shown in FIG. A portion on the inner surface 2a side and a portion on the outer surface 2b side of the sliding body 3 are folded back at a folding portion 3a.
  • the sliding body 3 can be slid so that the outer surface 2b and the inner surface 2a of the cylindrical body 2 are folded back, and deforms along the outer surface shape and the inner surface shape of the cylindrical body 2.
  • a distal end portion 2c of the cylindrical body 2 is a portion that contacts the folded portion 3a of the sliding body 3. As shown in FIG.
  • the tip portion 2c of the tubular body 2 has an R-shaped cross section (chamfered).
  • the sliding body 3 is passed from the base end side (the right side in FIG. 1) to the outside of the cylindrical body 2, pulled toward the distal end (the left direction in FIG. 1), and folded inward at the distal end portion 2c of the cylindrical body 2, and then folded back.
  • the inner surface 2a and the outer surface 2b of the cylindrical body 2 can be covered by pulling the bent portion in the proximal direction. Then, by pulling the inner end portion 31 located on the inner surface 2a side of the sliding body 3 toward the base end of the cylindrical body 2, the sliding body 3 slides from the outer surface 2b of the cylindrical body 2 to the inner surface 2a.
  • an elongated body 4 can be further included that can be axially advanced and retracted inside the tubular body 2 .
  • the inner end 31 of the slide 3 is connected to the elongate body 4, as shown in FIG.
  • the elongated body 4 functions as an operating section for operating the sliding body 3 . Therefore, the sliding body 3 can be caused to slide relative to the tubular body 2 simply by moving the elongated body 4 back and forth.
  • the sliding body 3 moves toward the circular shape of the cylindrical body 2 as indicated by the arrow. It is folded back along the circumferential direction at the folded portion 3a of the tip portion 2c (opening portion). The sliding body 3 folded back inward moves in the direction of the proximal end of the cylindrical body 2 in a belt conveyor manner while maintaining its cylindrical shape. At this time, the outer end portion 32 of the sliding body 3 moves on the outer side of the tubular body 2 in the distal direction.
  • the medical device 1 of the present invention is used to collect an object T (eg, excrement) present within a lumen L (eg, digestive tract, etc.).
  • the sliding member 3 is arranged so that the inner end portion 31 and the outer end portion 32 are in the vicinity of the proximal end portion 2 d of the tubular body 2 .
  • the medical device 1 is inserted into the body, and the cylindrical body 2 is advanced into the body cavity.
  • the cylindrical body 2 is placed at a position where the object T contacts the sliding body 3 (folded portion 3a) located at the tip 2c of the cylindrical body 2.
  • FIG. As shown in FIG. Then, as shown in FIG.
  • the proximal end portion 2d of the cylindrical body 2 is held with one hand, and the proximal end portion 4a of the elongated body 4 is held with the other hand in the proximal direction (rightward direction in FIG. 2B). ) is performed.
  • the elongated body 4 moves in the direction in which it is pulled out from the cylindrical body 2 .
  • the distal end portion 4b of the elongated body 4 retreats in the proximal direction of the cylindrical body 2.
  • a space for accommodating the object T within the cylindrical body 2 is secured.
  • the inner end portion 31 of the sliding body 3 connected to the elongated body 4 also moves relative to the tubular body 2 . relative to the proximal direction.
  • the sliding body 3 slides along the shape of the cylindrical body 2 from the outside to the inside like a belt conveyor.
  • FIG. 2A the object T, which is in contact with the sliding body 3 at the tip 2c of the cylindrical body 2, is pulled into the cylindrical body 2 by the sliding body 3, as shown in FIG. 2B.
  • the object T moves toward the proximal end of the tubular body 2 while its periphery is sandwiched between the sliding bodies 3 . Since the strip-shaped sliding body 3 continuously moves inside the cylindrical body 2 without interruption, the object T is drawn into the cylindrical body 2 and recovered while being appropriately crushed.
  • the medical device 1 After confirming that the object T has been properly collected inside the cylindrical body 2, the medical device 1 is pulled out from the lumen L. This time, conversely, an operation is performed to advance the elongated body 4 in the distal direction. By this operation, the connected sliding body 3 slides toward the distal end of the tubular body 2 . The object T is pushed out from the tip 2c of the cylindrical body 2. As shown in FIG. The extruded object T is used for inspection, culture, observation, and the like.
  • FIGSecond embodiment 3A and 3B are diagrams showing a medical device 1A according to a second embodiment of the invention.
  • the elongated body 4A is configured in a pipe shape having a cavity 4c inside.
  • the long body 4A has openings 4d at both ends.
  • an endoscope or the like can be inserted through the opening 4d on the side of the proximal end 4a and advanced from the opening 4d on the side of the distal end 4b to form a tubular shape.
  • the object T in the inside of the body 2 and in the tip direction can be observed.
  • the expansion body 5 is inserted inside the long body 4A.
  • the expansion body 5 includes a catheter 52 and a stretchable expansion section 51 (balloon) fixed to the catheter 52 .
  • the expansion body 5 is, for example, a balloon catheter.
  • the expandable body 5 can be advanced from the opening 4d on the distal end side of the elongated body 4A together with the catheter 52 while the expandable portion 51 is contracted.
  • extension 5 can position extension 51 beyond (distal to) object T within lumen L.
  • the object T is separated from the tip 2c of the tubular body 2 and has not yet come into contact with the sliding body 3.
  • an operation is performed to pull the catheter 52 in the proximal direction (rightward direction in FIG. 3) in the state of being pulled.
  • the expanded portion 51 thus pulled abuts against the object T, and the object T is guided to the distal end portion 2c of the tubular body 2 as the catheter 52 is pulled.
  • a guide wire may additionally be used with extension 51 .
  • the extension part 51 moves the object T toward the tip part 2c of the tubular body 2 .
  • the valve 41 arranged at the opening part 4d on the base end part 4a side of the long body 4A is pushed. is closed to fix the catheter 52 against the elongated body 4A.
  • the elongated body 4A is pulled in the proximal direction, the object T is pulled in by the sliding body 3, and the object T is collected inside the cylindrical body 2.
  • the elongated body 4A can be omitted, and in this case, the endoscope and the extension body 5 are inserted inside the tubular body 2. As shown in FIG.
  • blood flow can be stopped by the expanded portion 51, so that thrombi can be prevented from being swept away by the blood flow. Therefore, it is possible to collect the object T (thrombus) preferentially over blood, which is advantageous.
  • the object T thrombus
  • FIG. By shrinking the expansion part 51 and accommodating it in the tubular body 2 together with the object T, it is possible to prevent the lumen L from being damaged by the expansion part 51 when the medical device 1A is pulled out.
  • the medical device 1 can also be used to harvest a piece of tissue.
  • a step of making an incision 90 in the skin S is performed as shown in FIG. 4A. Incisions 90 are made at both ends of a length of exposed muscle fiber M (muscle ends).
  • the step of inserting the medical device 1 through the incision 90 is performed, as shown in FIG. 4B.
  • a step of retracting and storing the muscle fibers M (muscle pieces) cut to the length of the slider 3 is performed with the medical device 1 . If necessary, the end of the muscle that is incised and housed in the medical device 1 may be cauterized and ligated.
  • the medical devices 1 and 1A of the embodiments can be used, for example, sequentially by the following steps. (1) Providing the medical device 1, 1A (2) Bringing an object into contact with the sliding body 3 (3) Sliding the sliding body 3 (4) Collecting the object inside the cylindrical body 2
  • the sliding body 3 can also be slid by pulling the long body 4 connected to the sliding body 3 in the proximal direction.
  • the extension part 51 can be used to guide the object to the slide body 3 and retrieve it.
  • the object is guided by the expanding portion 51 for recovery, whereby the object can be recovered preferentially over blood. It is also possible to insert the medical device 1, 1A into the body cavity transperitoneally and recover the object in the body cavity.

Abstract

This medical device (1, 1A) for collecting an object includes a cylindrical body (2) and a sliding body (3) that covers at least a portion of the outer surface (2b) and inner surface (2a) of the cylindrical body (2) and slides so as to fold over the outer surface (2b) and inner surface (2a) at a fold section (3a) positioned on the tip end (2c) of the cylindrical body (2). By bringing the sliding body (3) into contact with the object (T) near the tip end (2c) of the cylindrical body (2) and sliding the sliding body (3) from the outer surface (2b) toward the inner surface (2a), the object (T) is pulled into the interior of the cylindrical body (2) and collected.

Description

物体の回収を行うための医療機器および方法Medical device and method for object retrieval
　本発明は、物体の回収を行うための医療機器および方法に関する。 The present invention relates to medical devices and methods for retrieving objects.
　心臓や大動脈壁等に形成された血栓が遊離して末梢の下肢動脈が閉塞すると、急性下肢虚血（ＡＬＩ：Acute limb ischemia）が生じる。急性下肢虚血の治療方法として、経カテーテル的直接血栓溶解療法（ＣＤＴ：Catheter-directed thrombolysis）、経皮的機械的血栓除去術（ＰＭＴ：Percutaneous mechanical thrombectomy）、経皮的吸引血栓除去術（ＰＡＴ：Percutaneous aspiration thrombectomy）等が知られている。 Acute limb ischemia (ALI: Acute limb ischemia) occurs when thrombi formed in the heart, aortic wall, etc. are released and peripheral lower limb arteries are occluded. As a treatment method for acute lower extremity ischemia, transcatheter-directed thrombolysis (CDT), percutaneous mechanical thrombectomy (PMT), percutaneous aspiration thrombectomy (PAT) : Percutaneous aspiration thrombectomy), etc. are known.
　しかし、血栓の寸法が大きい場合や、血栓が硬い場合には、皮膚から血管を穿刺して行う経皮的な方法では、血栓を除去することが困難である。したがって、血栓の寸法が大きい場合や、血栓が硬い場合には、バルーンを有するカテーテルによる血栓除去術が有効である。 However, if the size of the thrombus is large or the thrombus is hard, it is difficult to remove the thrombus by a percutaneous method in which a blood vessel is punctured through the skin. Therefore, thrombectomy using a catheter having a balloon is effective when the thrombus is large or hard.
　この方法では、外科的に皮膚を切開し、大腿動脈を露出させる。次に、大腿動脈を切開して血管内にカテーテルを挿入し、収縮したバルーンを伸ばして血栓による閉塞部（または狭窄部）を通過させた後にバルーンを拡張させる。この後、バルーンを近位側に引っ張ることで、血栓を血管の切開部まで移動させ、切開部から体外に除去する。しかし、この方法は、外科的な技術を要するため、医師の技術的習熟度に依存する。このため、患者への身体的負担が大きく、治療後の感染のリスクが高い。 In this method, the skin is surgically incised to expose the femoral artery. The femoral artery is then incised, a catheter is inserted into the vessel, and the deflated balloon is stretched to clear the blockage (or stenosis) caused by the thrombus before being inflated. The balloon is then pulled proximally to move the thrombus to the blood vessel incision and out of the body through the incision. However, this method requires surgical techniques and thus depends on the technical proficiency of the doctor. Therefore, the physical burden on the patient is large, and the risk of infection after treatment is high.
　そのため、例えば米国特許出願公開第２０１１／０２１３３９３号明細書には、皮膚を切開せずに、バルーンを有する血栓除去デバイスを血管に挿入して、血栓を除去する方法が記載されている。この方法は、血栓除去デバイスのバルーンによって血栓を引っ張り、血管内で拡張させた漏斗状の管体に収容する。この後、近位側から血栓を吸引し、漏斗状の管体内の血栓を体外へ排出できる。 Therefore, for example, US Patent Application Publication No. 2011/0213393 describes a method for removing a thrombus by inserting a thrombus removal device having a balloon into a blood vessel without incising the skin. In this method, the balloon of the thrombectomy device draws the thrombus into a funnel-shaped tube that is expanded within the vessel. After this, the thrombus can be aspirated from the proximal side, and the thrombus in the funnel-shaped tube can be expelled from the body.
　特開２０１８－１４３５７７号公報には、２つのシャフト部と、２つのシャフト部の遠位部から遠位側へ延在する切削部とを有し、前記切削部は、前記シャフト部に対して傾斜する切削刃を有する線状部を備えた医療デバイスが記載されている。このデバイスは、切削刃を備える線状部が、シャフト部に対して傾斜しているため、生体管腔内で物体が引き込まれる捕獲デバイスの中で移動することで、物体を効果的に破砕できる。 Japanese Patent Application Laid-Open No. 2018-143577 has two shaft portions and a cutting portion extending distally from the distal portions of the two shaft portions. A medical device is described with a linear portion having an angled cutting edge. In this device, since the linear part with the cutting blade is inclined with respect to the shaft part, the object can be effectively crushed by moving within the capture device into which the object is drawn inside the biological lumen. .
　米国特許出願公開第２０１１／０２１３３９３号明細書に記載のデバイスでは、漏斗状の管体内の血栓を、吸引力のみで細いシースを介して体外へ除去することは困難である。また、特開２０１８－１４３５７７号公報に記載のデバイスでは、構造が複雑で、血栓の破砕を必要とするため、血管を傷める恐れがある。 With the device described in US Patent Application Publication No. 2011/0213393, it is difficult to remove the thrombus in the funnel-shaped tube to the outside of the body through the thin sheath only by suction force. In addition, the device described in JP-A-2018-143577 has a complicated structure and requires crushing of thrombi, which may damage blood vessels.
　本発明は、上述した課題を解決するべく、簡単な機構と、簡単な操作で、生体内の物体を効率的に回収できる医療機器および方法を提供することを目的とする。 In order to solve the above-mentioned problems, the present invention aims to provide a medical device and method capable of efficiently recovering an in vivo object with a simple mechanism and a simple operation.
　すなわち本発明は、以下に関する。
［１］物体の回収を行うための医療機器であって、内部に前記物体を収容可能な筒状体と、前記筒状体の外面および内面の少なくとも一部を覆い、前記筒状体の先端部に位置する折返部を通じて前記外面と前記内面とを折り返すように摺動する摺動体と、を含み、前記筒状体の前記先端部で前記摺動体に前記物体を接触させて前記摺動体を前記外面から前記内面に向けて摺動させることにより、前記物体を前記筒状体の前記内部に引き込んで回収する、医療機器。
［２］前記摺動体は前記筒状体の前記内面に位置する内側端部を有し、前記筒状体の前記内部を進退可能に挿通し、前記摺動体の前記内側端部に接続された長尺体をさらに含む、［１］に記載の医療機器。
［３］前記筒状体または前記長尺体の内側に挿通された内視鏡をさらに含む、［２］に記載の医療機器。 That is, the present invention relates to the following.
[1] A medical device for retrieving an object, comprising: a tubular body capable of accommodating the object inside; a sliding body that slides so as to fold back the outer surface and the inner surface through a folded portion located at the end of the cylindrical body, and the object is brought into contact with the sliding body at the tip portion of the cylindrical body to move the sliding body. A medical device that draws the object into the interior of the tubular body and recovers the object by sliding the object from the outer surface toward the inner surface.
[2] The sliding body has an inner end located on the inner surface of the cylindrical body, is inserted reciprocally through the interior of the cylindrical body, and is connected to the inner end of the sliding body. The medical device according to [1], further comprising an elongated body.
[3] The medical device according to [2], further comprising an endoscope inserted inside the tubular body or the elongated body.
［４］前記筒状体または前記長尺体の内側に挿通された拡張体をさらに含み、前記拡張体は、カテーテルと前記カテーテルに固定された伸縮可能な拡張部とを有する、［２］または［３］に記載の医療機器。
［５］物体の回収を行うための方法であって、［１］～［４］のいずれかに記載の医療機器を提供するステップと、前記摺動体に前記物体を接触させるステップと、前記摺動体を摺動させるステップと、前記物体を前記筒状体の前記内部に回収するステップと、を含む、方法。
［６］前記医療機器が、前記筒状体の内側に挿通され、カテーテルと前記カテーテルに固定された伸縮可能な拡張部とを有する拡張体をさらに含み、前記接触させるステップが、前記拡張部を拡張させるステップ、前記カテーテルを引くステップ、および前記拡張部で前記物体を前記筒状体の前記先端部に誘導するステップを含む、［５］に記載の方法。 [4] further comprising an expandable body inserted inside the cylindrical body or the elongated body, the expandable body having a catheter and an extendable expandable part fixed to the catheter, [2] or The medical device according to [3].
[5] A method for recovering an object, comprising: providing the medical device according to any one of [1] to [4]; A method, comprising: sliding a moving body; and retrieving the object into the interior of the tubular body.
[6] The medical device further includes an expansion body inserted inside the tubular body and having a catheter and a stretchable expansion part fixed to the catheter, and the contacting step includes the expansion part. The method of [5], comprising expanding, pulling the catheter, and guiding the object to the distal end of the tubular body with the expansion.
　本発明によれば、簡単な機構と、簡単な操作で物体を回収することができるため、操作性や製造コストの点において大きなメリットがある。 According to the present invention, objects can be collected with a simple mechanism and simple operations, so there are great advantages in terms of operability and manufacturing costs.
図１は、本発明の第１実施態様に係る医療機器の先端部分を示す概念図である。FIG. 1 is a conceptual diagram showing the distal end portion of the medical device according to the first embodiment of the present invention. 図２Ａは、本発明の第１実施態様に係る医療機器およびその使用例を示す概念図であり、図２Ｂは図２Ａの医療機器の筒状体の内部に物体を回収する方法を示す概念図である。FIG. 2A is a conceptual diagram showing a medical device according to the first embodiment of the present invention and an example of its use, and FIG. 2B is a conceptual diagram showing a method of recovering an object inside the cylindrical body of the medical device of FIG. 2A. is. 図３Ａは、本発明の第２実施態様に係る医療機器とその使用例を示す概念図であり、図３Ｂは図３Ａの医療機器の筒状体の内部に物体を回収する方法を示す概念図である。FIG. 3A is a conceptual diagram showing a medical device according to a second embodiment of the present invention and an example of its use, and FIG. 3B is a conceptual diagram showing a method of recovering an object inside the cylindrical body of the medical device of FIG. 3A. is. 図４Ａは、第３実施態様における皮膚および筋線維を切開するステップの説明図であり、図４Ｂは図４Ａの切開部に図１の医療機器を入れるステップの説明図であり、図４Ｃは図１の医療機器に筋線維を収容するステップの説明図である。4A is an explanatory diagram of the step of incising the skin and muscle fibers in the third embodiment, FIG. 4B is an explanatory diagram of the step of inserting the medical device of FIG. 1 into the incision of FIG. 4A, and FIG. 1 is an illustration of the step of housing muscle fibers in one medical device; FIG.
　本発明において、「物体」とは、「固形の物体」であり、固形状の部分を含む物体である。物体は、例えば、生体内、管腔内または体腔内に存在する。物体の例としては、ポリープ、組織片、筋腫、筋肉片（筋線維）、消化管内の排泄物（便、硫酸バリウム製剤等）、血栓、留置物（ステント、フィルター等）、誤飲した異物、破断した医療機器の一部、残留した医療機器の一部または全部等が含まれる。 In the present invention, an "object" is a "solid object" and an object that includes a solid part. The object is, for example, in vivo, within a lumen, or within a body cavity. Examples of objects include polyps, tissue fragments, fibroids, muscle fragments (muscle fibers), excretions in the digestive tract (feces, barium sulfate preparations, etc.), thrombi, indwelling objects (stents, filters, etc.), accidentally ingested foreign substances, This includes part of a broken medical device, part or all of a remaining medical device, etc.
　本発明において、「医療機器」とは、ヒトもしくは動物の疾病の診断、治療もしくは予防に使用されること、またはヒトもしくは動物の身体の構造もしくは機能に影響を及ぼすことが目的とされている機械器具等を指す。 In the present invention, "medical device" means a machine intended to be used for the diagnosis, treatment or prevention of diseases in humans or animals, or to affect the structure or function of the human or animal body. It refers to equipment, etc.
　本発明において、「筒状体」とは、物体をその内側に収容して回収することができる、略筒形状の部材をいう。略筒形状とは、典型的には、例えば、１枚の板状部材を円形に丸めた、断面が円形の円筒状を含み、その内側に物体を収容して、体外に適切に回収することができる。すなわち、筒状体は、物体を収容する内面および該内面の反対側にある外面を有する、アーチ状の部分（アーチ状部）を有する。筒状体が、例えば、４枚の板状部材を連結した、断面が四角形の筒形状を有する場合は、アーチ状部はコの字形を含むロの字形であり、内側の凹んでいる面を内面、その反対側にある外側の突出している面を外面という。 In the present invention, a "cylindrical body" refers to a substantially cylindrical member in which an object can be stored and collected. A substantially cylindrical shape typically includes, for example, a cylindrical shape with a circular cross section obtained by rolling one plate-like member into a circular shape, and an object is accommodated inside it to be appropriately retrieved outside the body. can be done. That is, the tubular body has an arcuate portion (arcuate portion) having an inner surface for receiving the object and an outer surface opposite the inner surface. For example, when the tubular body has a tubular shape with a quadrangular cross section, in which four plate-shaped members are connected, the arch-shaped part has a square square shape including a U shape, and the inner concave surface is The inner surface and the opposite outer protruding surface are called the outer surface.
　筒状体が、上述のように１枚の板状部材を円形に丸めた、断面が円形の円筒状を有する場合は、アーチ状部はＣの字形を含むＯ（オー）の字形であり、内面および外面は曲面である。筒状体が、例えば、１枚の板状部材を半円形に丸めた、断面が半円形の半円筒状を有する場合は、アーチ状部はＣの字形であり、内面および外面は曲面である。すなわち、アーチ状部とは、筒状体におけるロの字形、コの字形、Ｏの字形、またはＣの字形のアーチ状の部分をいう。ロの字形はコの字形を、Ｏの字形はＣの字形を包含する。本発明において、アーチ状部の凹んでいる側を、内面、凹面、内側、内部、アーチ状部の突出している側を外面、凸面、外側、外部という場合がある。アーチ状は、弧状も含む。 When the cylindrical body has a cylindrical shape with a circular cross section obtained by rolling one plate-shaped member into a circle as described above, the arch-shaped part is an O shape including a C shape, The inner and outer surfaces are curved surfaces. For example, when the tubular body has a semi-cylindrical shape with a semi-circular cross section, which is obtained by rolling one plate member into a semi-circular shape, the arch-shaped part is C-shaped, and the inner and outer surfaces are curved surfaces. . That is, the arch-shaped portion refers to a square-shaped, U-shaped, O-shaped, or C-shaped arch-shaped portion of the cylindrical body. The square shape includes the U shape, and the O shape includes the C shape. In the present invention, the recessed side of the arcuate portion may be referred to as the inner surface, concave surface, inner side, inner side, and the protruding side of the arched portion may be referred to as the outer surface, convex surface, outer side, or outer side. The arch shape also includes an arc shape.
　アーチ状部の内面と外面のどちらか一方は平面であってもよく、例えば、内面が凹面で外面が平面、内面が平面で外面が凸面であってもよい。筒状体は剛性を有し、その凹面に物体を配置することで、物体を外部に離脱させることなく、適切に保持することができる。筒状体は、凹面を有するアーチ状部を少なくとも一部に有していればよく、断面が半円形、円形、四角形、多角形の部材でもよい。筒状体は、物体をその内側に適切に引き込むことができるように、長尺状であることが好ましい。筒状体は、管腔や体腔の形状に合わせて自由に屈曲できるように、可撓性を有する材料で構成することもできる。 Either the inner surface or the outer surface of the arch-shaped portion may be flat. For example, the inner surface may be concave and the outer surface may be flat, or the inner surface may be flat and the outer surface may be convex. The tubular body has rigidity, and by arranging an object on its concave surface, it is possible to properly hold the object without detaching it to the outside. The cylindrical body may have at least a portion of an arched portion with a concave surface, and may be a member with a semicircular, circular, quadrangular, or polygonal cross section. The tubular body is preferably elongated so that objects can be properly drawn into it. The tubular body can also be made of a flexible material so that it can be freely bent according to the shape of the lumen or body cavity.
　筒状体の材料としては、特に限定されず、各種公知の材料を単独でまたは複数組み合わせて用いることができる。このような材料としては、例えば、金属、軟質塩化ビニル樹脂、ポリウレタン樹脂、シリコーンゴム、天然ゴム、合成ゴム、スチレン－エチレン－ブチレン－スチレン共重合体（ＳＥＢＳ）、スチレン－エチレン－プロピレン－スチレン共重合体（ＳＥＰＳ）、エチレン酢酸ビニル共重合体（ＥＶＡ）、ナイロン等のポリアミド樹脂およびポリアミドエラストマー、ポリエチレンテレフタレート（ＰＥＴ）等のポリエステル樹脂およびポリエステルエラストマー、ポリエチレン等のオレフィン系樹脂、フッ素ゴム、フッ素樹脂、ポリスチレン、ポリメチルメタクリレート、ポリカーボネート、ポリイミド、ポリエーテルイミド、ポリエーテルエーテルケトン等が挙げられ、これらのうち１種または２種以上を組み合わせて用いることができる。 The material for the cylindrical body is not particularly limited, and various known materials can be used singly or in combination. Examples of such materials include metals, soft vinyl chloride resins, polyurethane resins, silicone rubbers, natural rubbers, synthetic rubbers, styrene-ethylene-butylene-styrene copolymers (SEBS), styrene-ethylene-propylene-styrene copolymers. Polymer (SEPS), ethylene vinyl acetate copolymer (EVA), nylon and other polyamide resins and polyamide elastomers, polyethylene terephthalate (PET) and other polyester resins and polyester elastomers, polyethylene and other olefinic resins, fluororubbers, fluororesins , polystyrene, polymethyl methacrylate, polycarbonate, polyimide, polyetherimide, polyetheretherketone, etc., and one or more of these may be used in combination.
　本発明において、「摺動体」とは、筒状体の表面に沿って摺動することができる帯状体をいう。一態様において、帯状体は、筒状体の面形状に沿って摺動できる筒形状を有する。摺動体は、筒状体の長軸方向に沿って摺動し、筒状体の先端部で折り返されることで、内面から外面、外面から内面に移動する。摺動体は、筒状体の外面から先端部で折り返されて内面に移動することで、筒状体上をベルトコンベアの様に摺動し、物体を摺動体に接触させることで、物体を筒状体の内部に引き込むことができる。 In the present invention, the "sliding body" refers to a belt-shaped body that can slide along the surface of a cylindrical body. In one aspect, the strip has a cylindrical shape that can slide along the surface shape of the cylindrical body. The sliding body slides along the longitudinal direction of the cylindrical body and is folded back at the tip of the cylindrical body, thereby moving from the inner surface to the outer surface and from the outer surface to the inner surface. The sliding body moves from the outer surface of the cylindrical body to the inner surface of the cylindrical body by being folded back at the tip, thereby sliding on the cylindrical body like a belt conveyor and bringing the object into contact with the sliding body, thereby moving the object into the cylinder. It can be pulled inside the body.
　本発明において、「長尺体」とは、筒状体内に進退可能に挿通することができる、長尺の部材をいう。長尺体は、その一部に摺動体の内側端部を接続することができ、長尺体を筒状体に対して相対的に進退させることで、摺動体を筒状体に対して相対的に動かすことができる。一態様において、長尺体は、内側に空洞を有するパイプ状に構成することもできる。そして、長尺体の内側に、内視鏡や拡張体を挿通して長尺体の先端から進出させることで、筒状体の先端方向にある物体の観察や誘導を行うこともできる。 In the present invention, the "long body" refers to a long member that can be inserted into the cylindrical body so as to advance and retreat. A part of the long body can be connected to the inner end of the sliding body, and by moving the long body relative to the tubular body, the sliding body can be moved relative to the tubular body. can be moved sensibly. In one aspect, the elongated body can also be configured in the shape of a pipe having a cavity inside. By inserting an endoscope or an expansion body inside the elongated body and advancing from the distal end of the elongated body, it is possible to observe and guide an object in the direction of the distal end of the cylindrical body.
　以下、本発明の好適な実施態様に係る医療機器について、図面を参照しつつ詳細に説明する。図１は、本発明の第１実施態様に係る医療機器の先端部分を示す概念図、図２は、本発明の第１実施態様に係る医療機器の使用例を示す概念図、図３は、本発明の第２実施態様に係る医療機器の変形例を示す図である。
　なお、本願における各図において、説明を容易とするため、各部材の大きさは、適宜強調されており、図示の各部材は、実際の大きさを示すものではない。 A medical device according to a preferred embodiment of the present invention will be described in detail below with reference to the drawings. FIG. 1 is a conceptual diagram showing the tip portion of the medical device according to the first embodiment of the present invention, FIG. 2 is a conceptual diagram showing a usage example of the medical device according to the first embodiment of the present invention, and FIG. It is a figure which shows the modification of the medical device which concerns on the 2nd embodiment of this invention.
In addition, in each drawing in the present application, the size of each member is appropriately emphasized for ease of explanation, and each member shown does not indicate the actual size.
（第１実施態様）
　まず、本発明の第１実施態様について説明する。
　図１に示されるように、本発明の第１実施態様に係る医療機器１は、筒状体２および摺動体３を含む。筒状体２は、円筒形状を有する長尺の円筒体であり、Ｏの字形のアーチ状部２１を有する。筒状体２の内面２ａは凹曲面、外面２ｂは凸曲面を成す。摺動体３は、筒状体２の形状に沿って摺動できる、円筒形状を有する長尺の帯状体である。摺動体３は、可撓性の樹脂シート、エラストマーシート、伸縮性のある布等によって構成される。摺動体３は、使用前の初期状態において、筒状体２の内面２ａの一部と、外面２ｂの一部とを覆う。摺動体３は、筒状体２の先端部２ｃに位置する折返部３ａを有する。摺動体３の内面２ａ側の部分と、外面２ｂ側の部分とは、折返部３ａで折り返されている。 (First embodiment)
First, the first embodiment of the invention will be described.
As shown in FIG. 1, a medical device 1 according to a first embodiment of the invention includes a tubular body 2 and a sliding body 3. As shown in FIG. The cylindrical body 2 is a long cylindrical body having a cylindrical shape, and has an O-shaped arch-shaped portion 21 . The inner surface 2a of the cylindrical body 2 has a concave surface and the outer surface 2b has a convex surface. The sliding body 3 is a long belt-like body having a cylindrical shape that can slide along the shape of the tubular body 2 . The sliding member 3 is made of a flexible resin sheet, elastomer sheet, elastic cloth, or the like. The sliding body 3 covers part of the inner surface 2a and part of the outer surface 2b of the cylindrical body 2 in the initial state before use. The sliding member 3 has a folded portion 3a positioned at the tip portion 2c of the cylindrical member 2. As shown in FIG. A portion on the inner surface 2a side and a portion on the outer surface 2b side of the sliding body 3 are folded back at a folding portion 3a.
　摺動体３は、筒状体２の外面２ｂおよび内面２ａを折り返すように摺動させることができ、筒状体２の外面形状および内面形状に沿って変形する。筒状体２の先端部２ｃは、摺動体３の折返部３ａに接する部分である。摺動体３の摺動を円滑にして摩耗を抑えるため、筒状体２の先端部２ｃは、断面がＲ形状をなしている（面取りされている）ことが望ましい。 The sliding body 3 can be slid so that the outer surface 2b and the inner surface 2a of the cylindrical body 2 are folded back, and deforms along the outer surface shape and the inner surface shape of the cylindrical body 2. A distal end portion 2c of the cylindrical body 2 is a portion that contacts the folded portion 3a of the sliding body 3. As shown in FIG. In order to allow the slide body 3 to slide smoothly and to suppress wear, it is desirable that the tip portion 2c of the tubular body 2 has an R-shaped cross section (chamfered).
　摺動体３は、例えば、筒状体２の基端側（図１右側）から外側に通し、先端方向（図１左方向）に引っ張り、筒状体２の先端部２ｃで内側に折り返し、折り返された部分を基端方向に引っ張ることで、筒状体２の内面２ａおよび外面２ｂを覆うことができる。そして、摺動体３の内面２ａ側に位置する内側端部３１を筒状体２の基端方向に引っ張ることで、摺動体３を筒状体２の外面２ｂから内面２ａに折り返すように摺動させることができる。 For example, the sliding body 3 is passed from the base end side (the right side in FIG. 1) to the outside of the cylindrical body 2, pulled toward the distal end (the left direction in FIG. 1), and folded inward at the distal end portion 2c of the cylindrical body 2, and then folded back. The inner surface 2a and the outer surface 2b of the cylindrical body 2 can be covered by pulling the bent portion in the proximal direction. Then, by pulling the inner end portion 31 located on the inner surface 2a side of the sliding body 3 toward the base end of the cylindrical body 2, the sliding body 3 slides from the outer surface 2b of the cylindrical body 2 to the inner surface 2a. can be made
　逆に摺動体３の外面２ｂに位置する外側端部３２を筒状体２の基端方向に引っ張ることで、摺動体３を筒状体２の内面２ａから外面２ｂに折り返すように摺動させることもできる。一態様において、図示のように、筒状体２の内側を軸方向に進退できる長尺体４をさらに含むことができる。この場合には、図２に示されるように、摺動体３の内側端部３１は、長尺体４に接続される。長尺体４は、摺動体３を操作するための操作部として機能する。したがって、長尺体４を進退させるだけで、摺動体３を筒状体２に対して相対的に摺動させることができる。 Conversely, by pulling the outer end portion 32 positioned on the outer surface 2b of the sliding body 3 toward the base end of the cylindrical body 2, the sliding body 3 is slid from the inner surface 2a of the cylindrical body 2 to the outer surface 2b. can also In one aspect, as shown, an elongated body 4 can be further included that can be axially advanced and retracted inside the tubular body 2 . In this case, the inner end 31 of the slide 3 is connected to the elongate body 4, as shown in FIG. The elongated body 4 functions as an operating section for operating the sliding body 3 . Therefore, the sliding body 3 can be caused to slide relative to the tubular body 2 simply by moving the elongated body 4 back and forth.
　このように、円筒形状の帯状体である摺動体３の内側端部３１を、筒状体２の基端方向に引っ張る場合、矢印で示されるように、摺動体３は筒状体２の円形の先端部２ｃ（開口部）の折返部３ａで周方向に沿って折り返される。内側に折り返された摺動体３は、円筒形状を維持しつつ筒状体２の基端方向にベルトコンベア式に移動していく。このとき、摺動体３の外側端部３２は、筒状体２の外側を先端方向に移動する。 In this way, when the inner end 31 of the sliding body 3, which is a cylindrical belt-shaped body, is pulled in the proximal direction of the cylindrical body 2, the sliding body 3 moves toward the circular shape of the cylindrical body 2 as indicated by the arrow. It is folded back along the circumferential direction at the folded portion 3a of the tip portion 2c (opening portion). The sliding body 3 folded back inward moves in the direction of the proximal end of the cylindrical body 2 in a belt conveyor manner while maintaining its cylindrical shape. At this time, the outer end portion 32 of the sliding body 3 moves on the outer side of the tubular body 2 in the distal direction.
　図２Ａに示されるように、本発明の医療機器１は、管腔Ｌ（例えば、消化管等）内に存在する物体Ｔ（例えば、排泄物）を回収するために使用される。まず、摺動体３は、内側端部３１および外側端部３２が筒状体２の基端部２ｄの近傍に来るように配置される。その後、医療機器１を体内に挿入し、筒状体２を体腔内に進める。筒状体２は、物体Ｔが筒状体２の先端部２ｃに位置する摺動体３（折返部３ａ）に接触させる位置に配置される操作が行われる。そして、図２Ｂに示されるように、筒状体２の基端部２ｄを一方の手で把持し、他方の手で長尺体４の基端部４ａを基端方向（図２Ｂの右方向）に引っ張る操作が行われる。 As shown in FIG. 2A, the medical device 1 of the present invention is used to collect an object T (eg, excrement) present within a lumen L (eg, digestive tract, etc.). First, the sliding member 3 is arranged so that the inner end portion 31 and the outer end portion 32 are in the vicinity of the proximal end portion 2 d of the tubular body 2 . After that, the medical device 1 is inserted into the body, and the cylindrical body 2 is advanced into the body cavity. The cylindrical body 2 is placed at a position where the object T contacts the sliding body 3 (folded portion 3a) located at the tip 2c of the cylindrical body 2. As shown in FIG. Then, as shown in FIG. 2B, the proximal end portion 2d of the cylindrical body 2 is held with one hand, and the proximal end portion 4a of the elongated body 4 is held with the other hand in the proximal direction (rightward direction in FIG. 2B). ) is performed.
　すなわち、長尺体４が筒状体２から引き抜かれる方向に移動する。この操作により、長尺体４の先端部４ｂが筒状体２の基端方向に後退する。これにより、筒状体２内に物体Ｔを収容するためのスペースを確保される。長尺体４は、筒状体２に対して相対的に基端方向に移動するため、長尺体４に接続された摺動体３の内側端部３１も同様に、筒状体２に対して相対的に基端方向に移動する。これにより、摺動体３は筒状体２の形状に沿って、外側から内側にベルトコンベア式に摺動する。 That is, the elongated body 4 moves in the direction in which it is pulled out from the cylindrical body 2 . By this operation, the distal end portion 4b of the elongated body 4 retreats in the proximal direction of the cylindrical body 2. As shown in FIG. Thereby, a space for accommodating the object T within the cylindrical body 2 is secured. Since the elongated body 4 moves in the proximal direction relative to the tubular body 2 , the inner end portion 31 of the sliding body 3 connected to the elongated body 4 also moves relative to the tubular body 2 . relative to the proximal direction. As a result, the sliding body 3 slides along the shape of the cylindrical body 2 from the outside to the inside like a belt conveyor.
　したがって、図２Ａにおいて、筒状体２の先端部２ｃで摺動体３に接触していた物体Ｔは、図２Ｂに示されるように、摺動体３によって筒状体２の内部に引き込まれる。物体Ｔはその周囲が摺動体３に挟まれた状態で筒状体２の基端方向に移動する。帯状の摺動体３は間断なく連続的に筒状体２の内側に移動するので、物体Ｔは、適度に圧し潰されながら筒状体２の内部に引き込まれて回収される。 Therefore, in FIG. 2A, the object T, which is in contact with the sliding body 3 at the tip 2c of the cylindrical body 2, is pulled into the cylindrical body 2 by the sliding body 3, as shown in FIG. 2B. The object T moves toward the proximal end of the tubular body 2 while its periphery is sandwiched between the sliding bodies 3 . Since the strip-shaped sliding body 3 continuously moves inside the cylindrical body 2 without interruption, the object T is drawn into the cylindrical body 2 and recovered while being appropriately crushed.
　物体Ｔが筒状体２の内部に適切に回収されたことを確認すると、医療機器１は管腔Ｌ内から引き抜かれる。今度は逆に長尺体４を先端方向に進出させる操作が行われる。この操作により、接続されている摺動体３は、筒状体２の先端方向に摺動する。物体Ｔは、筒状体２の先端部２ｃから押し出される。押し出された物体Ｔは、検査、培養、観察等に使用される。 After confirming that the object T has been properly collected inside the cylindrical body 2, the medical device 1 is pulled out from the lumen L. This time, conversely, an operation is performed to advance the elongated body 4 in the distal direction. By this operation, the connected sliding body 3 slides toward the distal end of the tubular body 2 . The object T is pushed out from the tip 2c of the cylindrical body 2. As shown in FIG. The extruded object T is used for inspection, culture, observation, and the like.
（第２実施態様）
　図３Ａおよび図３Ｂは、本発明の第２実施態様に係る医療機器１Ａを示す図である。本実施態様の医療機器１Ａにおいて、長尺体４Ａは、内側に空洞４ｃを有するパイプ状に構成されている。長尺体４Ａは両端に開口部４ｄを有し、例えば、基端部４ａ側の開口部４ｄから内視鏡等を挿通し、先端部４ｂ側の開口部４ｄから進出させることで、筒状体２の内部や先端方向にある物体Ｔを観察できる。 (Second embodiment)
3A and 3B are diagrams showing a medical device 1A according to a second embodiment of the invention. In the medical device 1A of this embodiment, the elongated body 4A is configured in a pipe shape having a cavity 4c inside. The long body 4A has openings 4d at both ends. For example, an endoscope or the like can be inserted through the opening 4d on the side of the proximal end 4a and advanced from the opening 4d on the side of the distal end 4b to form a tubular shape. The object T in the inside of the body 2 and in the tip direction can be observed.
　本実施態様においては、長尺体４Ａの内側には、拡張体５が挿通されているものとして説明する。拡張体５は、カテーテル５２とカテーテル５２に固定された伸縮可能な拡張部５１（バルーン）とを含む。拡張体５は、例えばバルーンカテーテルである。拡張体５は、拡張部５１を収縮させた状態で、カテーテル５２と共に長尺体４Ａの先端側の開口部４ｄから進出させることができる。図３Ａに示されるように、拡張体５は、拡張部５１を管腔Ｌ内にある物体Ｔを越えて（物体Ｔの遠位側に）配置することができる。このとき、物体Ｔは、筒状体２の先端部２ｃからは離れており、摺動体３にはまだ接触していない。 In the present embodiment, it is assumed that the expansion body 5 is inserted inside the long body 4A. The expansion body 5 includes a catheter 52 and a stretchable expansion section 51 (balloon) fixed to the catheter 52 . The expansion body 5 is, for example, a balloon catheter. The expandable body 5 can be advanced from the opening 4d on the distal end side of the elongated body 4A together with the catheter 52 while the expandable portion 51 is contracted. As shown in FIG. 3A, extension 5 can position extension 51 beyond (distal to) object T within lumen L. As shown in FIG. At this time, the object T is separated from the tip 2c of the tubular body 2 and has not yet come into contact with the sliding body 3. As shown in FIG.
　本実施態様の医療機器１Ａで、管腔Ｌ（例えば、血管等）内に存在する物体Ｔ（例えば、血栓等）を回収するためには、図３Ｂに示されるように、拡張部５１を拡張させた状態でカテーテル５２を基端方向（図３右方向）に引っ張る操作が行われる。引っ張られた拡張部５１は物体Ｔに当接し、カテーテル５２を引くにつれて物体Ｔは筒状体２の先端部２ｃに誘導される。ガイドワイヤーは、拡張部５１と共に追加的に使用されてもよい。拡張部５１によって、物体Ｔは筒状体２の先端部２ｃに向けて移動する。 In the medical device 1A of this embodiment, in order to retrieve an object T (eg, thrombus, etc.) present in the lumen L (eg, blood vessel, etc.), as shown in FIG. An operation is performed to pull the catheter 52 in the proximal direction (rightward direction in FIG. 3) in the state of being pulled. The expanded portion 51 thus pulled abuts against the object T, and the object T is guided to the distal end portion 2c of the tubular body 2 as the catheter 52 is pulled. A guide wire may additionally be used with extension 51 . The extension part 51 moves the object T toward the tip part 2c of the tubular body 2 .
　物体Ｔが誘導されて筒状体２の先端部２ｃに位置する摺動体３（折返部３ａ）に接触すると、長尺体４Ａの基端部４ａ側の開口部４ｄに配置されているバルブ４１を閉じて、カテーテル５２を長尺体４Ａに対して動かないように固定する。そして、上述のように、長尺体４Ａを基端方向に引っ張り、摺動体３によって物体Ｔを引き込んで筒状体２の内部に回収する操作が行われる。長尺体４Ａは省略することもでき、この場合、内視鏡や拡張体５は筒状体２の内側に挿通する。 When the object T is guided and comes into contact with the sliding body 3 (folding part 3a) located at the tip part 2c of the cylindrical body 2, the valve 41 arranged at the opening part 4d on the base end part 4a side of the long body 4A is pushed. is closed to fix the catheter 52 against the elongated body 4A. Then, as described above, the elongated body 4A is pulled in the proximal direction, the object T is pulled in by the sliding body 3, and the object T is collected inside the cylindrical body 2. As shown in FIG. The elongated body 4A can be omitted, and in this case, the endoscope and the extension body 5 are inserted inside the tubular body 2. As shown in FIG.
　本実施態様では、拡張部５１で血流を止めることができるため、血栓が血流で流されないようにできる。このため、血液よりも物体Ｔ（血栓）を優先的に回収することができ有利である。拡張された拡張部５１で長尺体４Ａの先端部４ｂに蓋をすることで、物体Ｔが筒状体２から離脱することを防ぐこともできる。拡張部５１を収縮させて物体Ｔと共に筒状体２内に収容することで、医療機器１Ａを引き抜く際に、拡張部５１で管腔Ｌを傷つけるようなことを防ぐこともできる。 In this embodiment, blood flow can be stopped by the expanded portion 51, so that thrombi can be prevented from being swept away by the blood flow. Therefore, it is possible to collect the object T (thrombus) preferentially over blood, which is advantageous. By covering the distal end portion 4b of the elongated body 4A with the extended extended portion 51, it is possible to prevent the object T from detaching from the cylindrical body 2. FIG. By shrinking the expansion part 51 and accommodating it in the tubular body 2 together with the object T, it is possible to prevent the lumen L from being damaged by the expansion part 51 when the medical device 1A is pulled out.
（第３実施態様）
　別の態様として、図４Ａ～図４Ｄに示されるように、医療機器１は、組織片の採取にも使用できる。組織片を採取する場合には、まず図４Ａに示されるように、皮膚Ｓに切開部９０をいれるステップが行われる。切開部９０は、露出した筋線維Ｍのある長さの両端（筋肉端部）に形成される。次に、図４Ｂに示されるように、切開部９０から医療機器１を挿入するステップが行われる。その後、図４Ｃに示されるように、医療機器１で摺動体３である長さに切開された筋線維Ｍ（筋肉片）を引き込んで収納するステップが行われる。必要に応じて切開して医療機器１に収容した筋肉端部を焼灼・結紮してもよい。 (Third embodiment)
Alternatively, as shown in Figures 4A-4D, the medical device 1 can also be used to harvest a piece of tissue. When collecting a piece of tissue, first, a step of making an incision 90 in the skin S is performed as shown in FIG. 4A. Incisions 90 are made at both ends of a length of exposed muscle fiber M (muscle ends). Next, the step of inserting the medical device 1 through the incision 90 is performed, as shown in FIG. 4B. After that, as shown in FIG. 4C, a step of retracting and storing the muscle fibers M (muscle pieces) cut to the length of the slider 3 is performed with the medical device 1 . If necessary, the end of the muscle that is incised and housed in the medical device 1 may be cauterized and ligated.
　実施態様の医療機器１、１Ａの使用は、例えば、以下の工程によって順次行うことができる。
（１）医療機器１、１Ａを提供する
（２）摺動体３に物体を接触させる
（３）摺動体３を摺動させる
（４）物体を筒状体２の内部に回収する The medical devices 1 and 1A of the embodiments can be used, for example, sequentially by the following steps.
(1) Providing the medical device 1, 1A (2) Bringing an object into contact with the sliding body 3 (3) Sliding the sliding body 3 (4) Collecting the object inside the cylindrical body 2
　（３）において、摺動体３に接続された長尺体４を基端方向に引っ張ることで、摺動体３を摺動させることもできる。（２）において、拡張部５１を物体の遠位側に伸ばし、カテーテル５２を引くことで、拡張部５１で物体を摺動体３に誘導して回収することもできる。（４）において、拡張部５１で物体（血栓）を誘導させて回収を行うことで、血液よりも物体を優先的に回収することができる。医療機器１、１Ａを体腔内に経腹腔的に挿入して、体腔内の物体を回収することもできる。 In (3), the sliding body 3 can also be slid by pulling the long body 4 connected to the sliding body 3 in the proximal direction. In (2), by extending the extension part 51 to the distal side of the object and pulling the catheter 52, the extension part 51 can be used to guide the object to the slide body 3 and retrieve it. In (4), the object (thrombus) is guided by the expanding portion 51 for recovery, whereby the object can be recovered preferentially over blood. It is also possible to insert the medical device 1, 1A into the body cavity transperitoneally and recover the object in the body cavity.
　以上のように、本発明によれば、簡単な機構と、簡単な操作で物体を回収することができるため、操作性や製造コストの点において大きなメリットがある。 As described above, according to the present invention, objects can be recovered with a simple mechanism and simple operations, so there are great advantages in terms of operability and manufacturing costs.

Claims (6)

  1. 　物体の回収を行うための医療機器であって、
    　内部に前記物体を収容可能な筒状体と、
    　前記筒状体の外面および内面の少なくとも一部を覆い、前記筒状体の先端部に位置する折返部を通じて前記外面と前記内面とを折り返すように摺動する摺動体と、を含み、
    　前記筒状体の前記先端部で前記摺動体に前記物体を接触させて前記摺動体を前記外面から前記内面に向けて摺動させることにより、前記物体を前記筒状体の前記内部に引き込んで回収する、医療機器。     A medical device for retrieving objects,
    a cylindrical body capable of accommodating the object inside;
    a sliding body that covers at least part of the outer surface and the inner surface of the cylindrical body and slides so as to fold back the outer surface and the inner surface through a folded portion located at the tip of the cylindrical body;
    The object is drawn into the interior of the tubular body by bringing the object into contact with the sliding body at the distal end portion of the tubular body and sliding the sliding body from the outer surface toward the inner surface. Medical equipment to collect.
  2. 　前記摺動体は前記筒状体の前記内面に位置する内側端部を有し、
    　前記筒状体の前記内部を進退可能に挿通し、前記摺動体の前記内側端部に接続された長尺体をさらに含む、請求項１に記載の医療機器。     the slider has an inner end located on the inner surface of the tubular body;
    2. The medical device according to claim 1, further comprising an elongated body that is movably inserted into the interior of the cylindrical body and connected to the inner end of the sliding body.
  3. 　前記筒状体または前記長尺体の内側に挿通された内視鏡をさらに含む、請求項２に記載の医療機器。 The medical device according to claim 2, further comprising an endoscope inserted inside the cylindrical body or the elongated body.
  4. 　前記筒状体または前記長尺体の内側に挿通された拡張体をさらに含み、
    　前記拡張体は、カテーテルと前記カテーテルに固定された伸縮可能な拡張部とを有する、請求項２または３に記載の医療機器。     further comprising an expansion body inserted inside the cylindrical body or the elongated body,
    4. The medical device of claim 2 or 3, wherein the expander comprises a catheter and a stretchable expander secured to the catheter.
  5. 　物体の回収を行うための方法であって、
    　請求項１～４のいずれか一項に記載の医療機器を提供するステップと、
    　前記摺動体に前記物体を接触させるステップと、
    　前記摺動体を摺動させるステップと、
    　前記物体を前記筒状体の前記内部に回収するステップと、
    　を含む、方法。     A method for retrieving an object, comprising:
    providing a medical device according to any one of claims 1-4;
    bringing the object into contact with the sliding body;
    sliding the sliding body;
    collecting the object into the interior of the tubular body;
    A method, including
  6. 　前記医療機器が、前記筒状体の内側に挿通され、カテーテルと前記カテーテルに固定された伸縮可能な拡張部とを有する拡張体をさらに含み、
    　前記接触させるステップが、
    　前記拡張部を拡張させるステップ、
    　前記カテーテルを引くステップ、および
    　前記拡張部で前記物体を前記筒状体の前記先端部に誘導するステップを含む
    　請求項５に記載の方法。     The medical device further includes an expander inserted inside the tubular body and having a catheter and an extendable expander secured to the catheter,
    The contacting step includes
    expanding the extension;
    6. The method of claim 5, comprising pulling the catheter and guiding the object to the distal end of the barrel with the extension.
PCT/JP2022/036630 2021-09-30 2022-09-30 Medical device and method for collecting object WO2023054658A1 (en)

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2009082536A (en) * 2007-10-01 2009-04-23 Olympus Medical Systems Corp Ligature appliance for endoscope and endoscope ligature system
JP2019514649A (en) * 2016-04-25 2019-06-06 ストライカー コーポレイションＳｔｒｙｋｅｒ Ｃｏｒｐｏｒａｔｉｏｎ A mechanical thrombus removal device that encloses a clot
JP2021522952A (en) * 2018-05-14 2021-09-02 ストライカー コーポレイションＳｔｒｙｋｅｒ Ｃｏｒｐｏｒａｔｉｏｎ Inverted thrombectomy device and how to use

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2009082536A (en) * 2007-10-01 2009-04-23 Olympus Medical Systems Corp Ligature appliance for endoscope and endoscope ligature system
JP2019514649A (en) * 2016-04-25 2019-06-06 ストライカー コーポレイションＳｔｒｙｋｅｒ Ｃｏｒｐｏｒａｔｉｏｎ A mechanical thrombus removal device that encloses a clot
JP2021522952A (en) * 2018-05-14 2021-09-02 ストライカー コーポレイションＳｔｒｙｋｅｒ Ｃｏｒｐｏｒａｔｉｏｎ Inverted thrombectomy device and how to use

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